rubrica

Screening

  • Paolo Giorgi Rossi1

  1. Laziosanità, Agenzia di sanità pubblica, Roma
Paolo Giorgi Rossi -

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Ricerca bibliografica periodo 02 agosto 2011 – 15 ottobre 2011

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Database: Pubmed/MEDline
Stringa: ("mass screening"[MeSH Terms] OR cancer[Title/Abstract] AND screening[Title/Abstract] AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2011/08/02"[PDAT] : "2011/10/15"[PDAT])

Commento generale a cura di Paolo Giorgi Rossi
In questi due mesi sono usciti solo 5 lavori e un editoriale prodotti da gruppi di ricerca italiani sullo screening: tre sul colon retto (Segnan et al; Castiglione et al; Kalimutho et al.), due sul polmone (Barba et al; Rampinelli et al.) e infine l’editoriale su Lancet Oncoloy (Ronco et al.) riguarda lo screening della cervice uterina. Fra questi ce ne è uno (Segnan et al.) che aggiunge qualcosa di rilevante alle conoscenze sull’efficacia dei test per lo screening del colon retto: SCORE, il trial sull’efficacia di una sola sigmoidoscopia all’età di 60 anni coordinato dal CPO del Piemonte. Questa strategia di screening si è rivelata efficace nel ridurre l’incidenza del 18% (rate ratio [RR] = 0.82, 95% confidence interval [CI] = 0.69 - 0.96), e la mortalità del 22% sebbene la differenza non sia significativa (RR = 0.78; 95% CI = 0.56 - 1.08) anche nell’analisi intention to treat. Il dato è ancora più impressionante se si pensa che l’effetto è diluito dal fatto che solo il 58% dei soggetti nel gruppo randomizzato all’intervento ha effettuato una sigmoidoscopia. Nella per-protocol analysis, la diminuzione di incidenza e di mortalità è maggiore e statisticamente significativa per entrambi gli outcome: 31% per l’incidenza (RR = 0.69; 95% CI = 0.56 - 0.86) e 38% per la mortalità (RR = 0.62; 95% CI = 0.40 - 0.96). Dal momento che l’effetto osservato nell’analisi intention to treat corrisponde esattamente all’effetto osservato nell’analisi per protocol, diluito per una mancanza totale di effetto nei non aderenti, non vi è motivo di credere che ci sia un rilevante bias di selezione e possiamo dunque affermare che una sola rettosigmoidoscopia all’età di 60 anni riduce probabilità di morire per cancro del colonretto del 38% nei successivi 10 anni. I risultati sono in linea con quelli dello studio inglese pubblicato poco più di un anno fa (Atkin et al, 2010). La conferma data da SCORE obbliga a ripensare le possibili strategie dei programmi organizzati di screening per il cancro del colon-retto, alla luce del fatto che ora sono due le strategie di comprovata efficacia: una sola sigmoidoscopia a 60 anni e sangue occulto biennale fra 50 e 70 anni. Fra gli altri studi usciti notiamo che ben due si occupano di microRNA come possibili biomarcatori da utilizzare nello screening, uno (Kalimutho et al.) dimostrando la resistenza dei microRNA nelle feci, ne propone uno come biomarcatore per il cancro del colonretto, un secondo lavoro (Barba et al.) propone dei microRNA come biomaratori di progressione per caratterizzare i noduli polmonari screen detected e ridurre così la possibilità di sovratrattamento.

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Castiglione G, Visioli CB, Zappa M, Grazzini G, Mallardi B, Mantellini P. Familial risk of colorectal cancer in subjects attending an organised screening programme. Dig Liver Dis. 2011 Sep 16. [Epub ahead of print]
Screening Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
Abstract
BACKGROUND:
First degree relatives of colorectal cancer patients are at increased risk for the same disease.
AIM:
To evaluate the prevalence of familial risk and its association with the occurrence of pathological significant lesions in subjects with positive faecal occult blood testing leading to colonoscopy.
METHODS:
Faecal occult blood testing is offered biennially to subjects aged 50-70. Subjects with a positive faecal test are invited to undergo colonoscopy. Familial history for colorectal cancer in subjects undergoing colonoscopy was routinely recorded.
RESULTS:
From 1995 to 2009, 4833 screenees with positive faecal occult blood test undergoing colonoscopy were enrolled. Twelve percent reported a positive first degree family history. Multivariate analysis evidenced that the probability of detecting pathological significant lesions was statistically associated with age, gender, type of test, repeated or first screening, and having at least 1 first degree relative with colorectal cancer.
CONCLUSION:
Subjects attending colonoscopy reporting a positive first degree family history are at increased risk for pathologically significant lesions.
2. Ronco G, Franceschi S, Segnan N. HPV16 and HPV18 genotyping in cervical cancer screening. Comment on Lancet Oncol. 2011 Sep;12(9):880-90.
Centre of Cancer Prevention, Turin, Italy. guglielmo.ronco@cpo.it .
3. Kalimutho M, Del Vecchio Blanco G, Di Cecilia S, Sileri P, Cretella M, Pallone F, Federici G, Bernardini S. Differential expression of miR-144* as a novel fecal-based diagnostic marker for colorectal cancer. J Gastroenterol. 2011 Aug 24. [Epub ahead of print]
Department of Internal Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy, mceric_rugan@hotmail.com.
Abstract
BACKGROUND:
MicroRNAs (miRNA) are tiny, noncoding, small, endogenous RNAs that play major roles in neoplastic transformation and could therefore offer a better quantitative and noninvasive method for the diagnosis and prognosis of colorectal cancer (CRC) using feces. In the present study, we screened feces for 648 miRNAs and analyzed the role of miR-144* as a potential CRC diagnostic marker.
METHODS:
Fecal miRNA expression was profiled with RT-pre-amplification-qPCR, and the stability was determined using both endogenous and exogenous miRNA by RT-qPCR. ROC analysis was performed to enhance the diagnosing power of the CRC patients' fecal specimens.
RESULTS:
We detected 39% of all the miRNAs screened in feces. Endogenous miRNAs are more stable over time and temperature, while exogenous miRNAs degraded rapidly. miR-144* was overexpressed in feces, suggesting that it could be a potent candidate diagnostic marker for CRC detection, with a sensitivity of 74% and a specificity of 87% (n = 75, p < 0.0001). Moreover, RT-qPCR analysis showed that miR-144* was also overexpressed in paired CRC tissues, thus suggesting its possible utilization as a diagnostic marker.
CONCLUSION:
We demonstrated that miRNAs are stable in the fecal microenvironment, and that, among them, miR-144* represents a novel fecal-based diagnostic marker for CRC screening. Nevertheless, our data need to be validated in a large cohort of subjects.
4. Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, Andreoni B, Arrigoni A, Bisanti L, Casella C, Crosta C, Falcini F, Ferrero F, Giacomin A, Giuliani O, Santarelli A, Visioli CB, Zanetti R, Atkin WS, Senore C; and the SCORE Working Group. Once-Only Sigmoidoscopy in Colorectal Cancer Screening: Follow-up Findings of the Italian Randomized Controlled Trial--SCORE. J Natl Cancer Inst. 2011 Sep 7;103(17):1310-22. Epub 2011 Aug 18.
Epidemiology Unit, CPO Piemonte and S. Giovanni University Hospital, Via S Francesco da Paola 31, 10123 Torino, Italy. nereo.segnan@cpo.it.
Abstract
BACKGROUND:
A single flexible sigmoidoscopy at around the age of 60 years has been proposed as an effective strategy for colorectal cancer (CRC) screening.
METHODS:
. We conducted a randomized controlled trial to evaluate the effect of flexible sigmoidoscopy screening on CRC incidence and mortality. A questionnaire to assess the eligibility and interest in screening was mailed to 236 568 men and women, aged 55-64 years, who were randomly selected from six trial centers in Italy. Of the 56 532 respondents, interested and eligible subjects were randomly assigned to the intervention group (invitation for flexible sigmoidoscopy; n = 17 148) or the control group (no further contact; n = 17 144), between June 14, 1995, and May 10, 1999. Flexible sigmoidoscopy was performed on 9911 subjects. Intention-to-treat and per-protocol analyses were performed to compare the CRC incidence and mortality rates in the intervention and control groups. Per-protocol analysis was adjusted for noncompliance.
RESULTS:
A total of 34 272 subjects (17 136 in each group) were included in the follow-up analysis. The median follow-up period was 10.5 years for incidence and 11.4 years for mortality; 251 subjects were diagnosed with CRC in the intervention group and 306 in the control group. Overall incidence rates in the intervention and control groups were 144.11 and 176.43, respectively, per 100 000 person-years. CRC-related death was noted in 65 subjects in the intervention group and 83 subjects in the control group. Mortality rates in the intervention and control groups were 34.66 and 44.45, respectively, per 100 000 person-years. In the intention-to-treat analysis, the rate of CRC incidence was statistically significantly reduced in the intervention group by 18% (rate ratio [RR] = 0.82, 95% confidence interval [CI] = 0.69 to 0.96), and the mortality rate was non-statistically significantly reduced by 22% (RR = 0.78; 95% CI = 0.56 to 1.08) compared with the control group. In the per-protocol analysis, both CRC incidence and mortality rates were statistically significantly reduced among the screened subjects; CRC incidence was reduced by 31% (RR = 0.69; 95% CI = 0.56 to 0.86) and mortality was reduced by 38% (RR = 0.62; 95% CI = 0.40 to 0.96) compared with the control group.
CONCLUSION:
A single flexible sigmoidoscopy screening between ages 55 and 64 years was associated with a substantial reduction of CRC incidence and mortality.
5. Rampinelli C, Preda L, Maniglio M, Sirica L, Travaini LL, Veronesi G, Bellomi M. Extrapulmonary malignancies detected at lung cancer screening. Radiology. 2011 Oct;261(1):293-9. Epub 2011 Aug 9.
Departments of Radiology, Data Management, Nuclear Medicine, and Thoracic Surgery, European Institute of Oncology, Via Ripamonti, 435-20141 Milan, Italy.
Abstract
PURPOSE:
To retrospectively assess the detection rate, histologic characteristics, and clinical stage of screening-detected extrapulmonary malignancies in a population at high risk for lung cancer.A single flexible sigmoidoscopy at around the age of 60 years has been proposed as an effective strategy for colorectal cancer (CRC) screening.
MATERIALS AND METHODS:
In this institutional review board-approved study, 5201 asymptomatic heavy smokers aged 50 years or older underwent annual low-dose computed tomography (CT) for 5 consecutive years. The 5-year cumulative effective dose was 5 mSv. Subjects with at least one "potentially significant extrapulmonary incidental finding" (PS-IF) were extracted from the study database. An extrapulmonary finding was classified as potentially significant if it required further diagnostic and/or clinical evaluation. In retrospect all clinically relevant information, including findings from diagnostic work-up and final diagnosis of the PS-IF, was collected. On the basis of the information collected, only histologically proved screening-detected extrapulmonary malignancies were eventually included in this study. The percentages of volunteers with extrapulmonary malignancies were calculated, along with 95% confidence intervals (CIs), on the basis of a binomial distribution.
RESULTS:
After 5 years of CT screening, 27 unsuspected extrapulmonary malignancies were diagnosed, representing 0.5% (27 of 5201 subjects; 95% CI: 0.34%, 0.75%) of volunteers enrolled and 6.2% (27 of 436 findings; 95% CI: 4.12%, 8.88%) of PS-IFs. Eight malignancies were diagnosed at the 1st year of screening, nine at the 2nd year, four at the 3rd year, two at the 4th year, and four at the 5th year. Twelve of the 27 extrapulmonary tumors (44%) were renal carcinomas (n = 7) or lymphomas (n = 5). Twenty-four of the 27 subjects with a malignancy were alive at the most recent follow-up.
CONCLUSION:
A considerable number of unsuspected extrapulmonary malignancies can be detected in lung cancer screening trials. A careful evaluation of extrapulmonary structures, with particular attention to the kidneys and lymph nodes, is recommended.

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